Most Americans, when pressed, have a vague sense of how they would like to die. They may imagine a quick and painless end or a gentle passing away during sleep. Some may wish for time to prepare and make peace with themselves, their friends, and their families. Others would prefer not to know what's coming, a swift, clean break. Yet all fear that the reality will be painful and prolonged; all fear the loss of control that could accompany dying. That fear is justified. It is also historically unprecedented. In the past thirty years, the advent of medical technology capable of sustaining life without restoring health, the expectation that a critically ill person need not die, and the conviction that medicine should routinely thwart death have significantly changed where, when, and how Americans die and put us all in the position of doing something about death. In a penetrating and revelatory study, medical anthropologist Sharon R. Kaufman examines the powerful center of those changes -- the hospital, where most Americans die today. In the hospital world, the deep, irresolvable tension between the urge to extend life at all costs and the desire to allow "letting go" is rarely acknowledged, yet it underlies everything that happens there among patients, families, and health professionals. Over the course of two years, Kaufman observed and interviewed critically ill patients, their families, doctors, nurses, and other hospital staff at three community hospitals. In...And a Time to Die, her research places us at the heart of that science-driven yet fractured and often irrational world of health care delivery, where empathetic yet frustrated, hard-working yet constrained professionals both respond to and create the anxieties and often inchoate expectations of patients and families, who must make "decisions" they are ill-prepared to make. Filled with actual conversations between patients and doctors, families and hospital staff,...And a Time to Die clearly and carefully exposes the reasons for complicated questions about medical care at the end of life: for example, why "heroic" treatment so often overrides "humane" care; why patients and families are ambivalent about choosing death though they claim to want control; what constitutes quality of life and life itself; and, ultimately, why a "good" death is so elusive. In elegant, compelling prose, Kaufman links the experiences of patients and families, the work of hospital staff, and the ramifications of institutional bureaucracy to show the invisible power of the hospital system itself -- its rules, mandates, and daily activity -- in shaping death and our individual experience of it. ...And a Time to Die is a provocative, illuminating, and necessary read for anyone working in or navigating the health care system today, providing a much-needed road map to the disorienting territory of the hospital, where we all are asked to make life-and-death choices.
Sharon R. Kaufman is professor of medical anthropology at the University of California, San Francisco. She is the author of numerous articles, book chapters, and two previous books: The Ageless Self: Sources of Meaning in Late Life (a New York Times Book Review Notable Book) and The Healer's Tale: Transforming Medicine and Culture. She lives with her husband in the San Francisco Bay Area.
Thomas Lynch author of The Undertaking, Life Studies from the Dismal Trade and Bodies in Motion and at Rest: On Metaphor and Mortality. Kaufman works those difficult borders between medicine and humanity, between "holding on" and "letting go," between sickness and ceasing to be -- drawing the reader nigh (to paraphrase Wallace Stevens) not only the idea of the thing, but the thing itself. Here is a compelling witness to how we manage mortality and what it means. A neccessary text for professional and common readers.
Muriel Gillick, MD Associate Professor Harvard Medical School, author of Lifelines: Living Longer, Growing Frail, Taking Heart Kaufman brilliantly captures the ethos of the American intensive care unit. I can no longer walk into the ICU of the teaching hospital where I practice without hearing the relentless drumbeat that Kaufman describes, the rhythm marking that special sense of time evident only to the physicians and nurses in the ICU. It is a clock that tells practitioners when to "do everything" and when to withdraw treatment, a clock whose ticking is often inaudible to patients and families, with sometimes tragic consequences. This is a book that anyone who wants to understand the contemporary American hospital should read.
Howard Spiro M.D. Emeritus Professor of Medicine Yale University School of Medicine and author of The Power of Hope: A Doctor's Perspective Reading this book is like listening in on the conversations and problems that American physicians have in caring for the dying and their families, the tragic choices for which nobody-not even living wills-- can really plan. Sharon Kaufmann vividly describes the harrowing scenarios, impossible for anyone to control, awaiting those of us who must die in hospitals, or more realistically begin the "process of dying," so transformed and so stretched by modern technology. There are good routines for medical care and for cure, but patients and their families, physicians and other "healthcare workers", have such different concepts of life and consciousness, of dignity and duty, of faith and obligation , that there can never be agreement on how we die or how we should die.
Robert N. Butler, M.D., President and CEO International Longevity Center USA This fine work, Sharon Kaufman's new book, should help policy makers and physicians transform the experience and culture of death in America.